Valley Health Services Inc

Inspectors wroteBased on observations, record review, and interviews during the recertification survey the facility failed to ensure a resident's ability to safely self-administer medications was clinically appropriate for two (2) of (2) residents (Residents #4 and #137) reviewed, and three anonymous residents present at the resident group meeting. Specifically, Residents #4 and #137 applied their own prescription creams without an order or assessment for their ability to do so; and three anonymous residents present at the resident group meeting stated they wanted to administer their own medications or creams and were told by facility staff they could not be assessed to do so.

Inspectors wroteBased on observations, record review, and interviews during the recertification survey, the facility failed to ensure residents who required nephrostomy tubes (a tube that drains urine from the kidney through an opening in the skin) received services consistent with professional standards of practice for one (1) of one (1) resident (Resident #161) reviewed. Specifically, Resident #161 had a nephrostomy tube and the physician orders did not include specific instructions to document the description of the output, when to change the drainage bag, to monitor for tube patency or blockage, and to monitor for signs and symptoms of infection; the care plan did not include care instructions or indicate what to monitor for and report; and staff were unsure if licensed practical nurses or certified nurse aides were responsible the drainage bag was emptied, measured, and documented. [...]

Inspectors wroteBased on observations, record review, and interviews during the recertification survey, the facility failed to ensure they established and maintained an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development of transmission of communicable diseases and infections for two (2) of six (6) residents (Resident #5 and #137) reviewed, and for the facility legionella (a bacteria in water that can cause Legionnaire's disease) program. Specifically,-Resident #5 was on enhanced barrier precautions for a urinary catheter (drains urine from the bladder through a tube). Urinary catheter care was provided by Certified Nurse Aide #6 and precautions were not followed; Licensed Practical Nurse #5 did wear appropriate personal protective equipment when administering medications; [...]

Inspectors wroteBased on observations, record review, and interview during the recertification survey, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, for one (1) of one (1) resident (Resident #144) reviewed. Specifically, Resident #144 did not have their tap bell (manual device used to request assistance) in reach when out of their room as planned.

Inspectors wroteBased on observations, record review, and interviews during the recertification survey, the facility failed to provide ongoing programs to support each resident in their choice of activities, for one (1) of one (1) Resident (Resident #70) reviewed. Specifically, Resident #70 did not have a person-centered care plan that reflected their interests and preferences and was not offered meaningful activities that met their interests and preferences.

Inspectors wroteBased on observation, record review, and interview during the recertification survey, the facility did not ensure a resident with limited mobility received appropriate services, equipment, and assistance to maintain or improve mobility for one (1) of one (1) resident (Resident #115) reviewed. Specifically, Resident #115 was not re-evaluated by therapy for positioning in their Broda chair (a specialty positioning wheelchair) and staff used a wedge pillow in the chair which did not maintain proper body alignment.

Inspectors wroteBased on observations, record review, and interviews during the recertification survey, the facility failed to ensure that residents who required dialysis (used to filter waste products from the blood when the kidneys stop working properly) received such services consistent with professional standards of practice for one (1) of one (1) resident (Resident #117) reviewed. Specifically, Resident #117 received hemodialysis treatments at a community-based dialysis center and did not have on-going assessments and oversight before and after dialysis treatments including assessment of the dialysis access site, and there was not consistent ongoing communication and collaboration between the facility and the dialysis center.

Inspectors wroteBased on observations, record review, and interviews during the recertification survey, the facility failed to ensure a residents who was a trauma survivor received culturally competent, trauma-informed care in accordance with professional standards of practice and accounting for the resident's experiences and preferences in order to eliminate or mitigate triggers that may cause re-traumatization of the resident for one (1) of one (1) resident (Resident #7) reviewed. Specifically, Resident #7 had a history of trauma with episodes of night terrors, and did not have a person centered care plan to address potential triggering events to avoid re-traumatization; and there was no social work follow up addressing the resident's night terrors.

Inspectors wroteBased on observations, record review, and interview during the recertification survey the facility failed to ensure that residents who displayed or were diagnosed with a mental disorder or psychosocial adjustment difficulty, received appropriate treatment and services to correct the assessed problem to attain the highest practicable mental and psychosocial well-being for one (1) of one (1) resident (Resident #136) reviewed. Specifically, Resident #136 exhibited symptoms of depression following their admission to the facility and need for long-term care and did not receive mental health counseling or routine psychiatric evaluations.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure residents were free of any significant medication errors for one (1) of one (1) resident (Resident #5) reviewed. Specifically, Resident #5 was administered lispro insulin (a fast-acting insulin) that was opened and undated.

Inspectors wroteBased on observations and interviews the facility failed to ensure a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for one (1) of four (4) shower/tub units (2 [NAME] shower/tub unit) reviewed. Specifically, four anonymous residents present at the resident group meeting stated the shower/tub floors were a mess, the drains did not work, and the tubs leaked. The shower/tub unit on 2 [NAME] was observed to have standing, discolored water underneath it for multiple days of survey.

Inspectors wroteBased on observations and interview during the recertification survey, the facility failed to post on a daily basis at the beginning of each shift, the current resident census and the total number and the actual hours worked by licensed and unlicensed nursing staff directly responsible for resident care per shift, in a prominent location readily accessible to residents and visitors for five (5) of five (5) days (01/05/2025-01/09/2025). Specifically, the current daily resident census, staffing hours, and nurse staffing schedules were located on the Unit 1 [NAME] nursing office door and window that was not easily accessible to all visitors or residents.

Inspectors wroteBased on record review and interview during the abbreviated survey (NY00337472), the facility did not ensure that residents received treatment and care in accordance with professional standards of practice for 1 of 3 residents (Resident #3) reviewed. Specifically, Resident #3 sustained a head injury from a fall and neurological checks were not performed during the time the resident awaited transport to the hospital.

Inspectors wroteBased on observation, record review, and interviews during the recertification and abbreviated (NY00310705, NY00312631, NY00313972, and NY00328391) surveys conducted 1/8/2024-1/12/2024, the facility did not ensure sufficient nursing staff was provided for nursing care to ensure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being for 12 of 12 anonymous residents who expressed concerns regarding lack of sufficient staffing and not receiving care in a timely manner. Specifically, during a confidential group meeting (resident council) 12 residents stated they had long wait times for receiving assistance with care. Additionally, deficiencies related to staffing were identified in the areas of Posted Nurse Staffing Information (F732), Resident Rights (F 550), and Infection Control (F 880).

Inspectors wroteBased on observation, record review, and interviews during the recertification and abbreviated (NY00328391) surveys conducted 1/8/2024-1/12/2024, the facility did not establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment, and to help prevent the development and transmission of communicable diseases and infections for 3 of 3 staff members (certified nurse aides #17 and #28, and food service worker #18) observed. Specifically, certified nurse aide #17 did not don and doff personal protective equipment as required when entering and exiting rooms with COVID-19 positive residents, did not perform hand hygiene, and placed an unclean face shield on a kitchenette counter; [...]

Inspectors wroteBased on observation, record review, and interviews during the recertification and abbreviated (NY00290651, NY00310705, and NY00312631) surveys conducted 1/8/2024-1/12/2024, the facility did not ensure residents were treated with respect and dignity for 3 of 5 residents (Residents #26, #38, and #110) reviewed. Specifically, Resident #26 had soiled clothing and an unclean wheelchair; Resident #38 was assisted with eating by registered nurse #9 and licensed practical nurse #10 who stood over them while feeding; and certified nurse aide #17 was observed speaking loudly about Resident #110's colostomy care and could be heard by anyone in the vicinity.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 1/8/2024-1/12/2024, the facility did not develop and implement a comprehensive person-centered care plan for each resident to meet medical and nursing needs for 1 of 1 resident (Resident #46) reviewed. Specifically, Resident #46 had a physician order to elevate their legs when out of bed and the order was not implemented.

Inspectors wroteBased on observation and interview during the recertification and abbreviated surveys (NY00310705 NY00312631, NY00313972, and NY00328391) conducted 1/8/2024-1/12/2024, the facility did not post on a daily basis at the beginning of each shift, the current resident census and the total number and the actual hours worked by licensed and unlicensed nursing staff directly responsible for resident care per shift, in a prominent location readily accessible to residents and visitors for 4 of 5 days. Specifically, the current daily resident census and nurse staffing schedules were located on the Unit 1 [NAME] nursing office door that was not easily accessible to visitors or residents.

Inspectors wroteBased on observation, record review, and interviews during the recertification and abbreviated (NY00328391) surveys conducted 1/8/2024-1/12/2024, the facility did not ensure a resident who displays or is diagnosed with dementia receives the appropriate treatment and services to attain and or maintain their highest practicable physical, mental, and psychosocial well-being for 1 of 4 residents (Resident #45) reviewed. Specifically, Resident #45 who had a diagnosis of dementia, made suicidal statements that were not addressed by the facility. The facility policy Suicide Precautions reviewed 03/2023 documented immediate protective response would be provided, physically and emotionally, to any resident that expressed suicidal plans, thoughts, or attempts. [...]

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 1/8/2023-1/12/2023, the facility did not ensure food was stored and prepared in accordance with professional standards for food service safety in 1 of 1 main kitchen. Specifically, the mechanical dishwasher was not maintained, clean utensils were not properly stored, uncleanable surfaces were present in the walk-in cooler, and the walk-in cooler was soiled.

Inspectors wroteBased on observation, record review and interview during the recertification and abbreviated surveys (NY00284242) conducted from 11/15/21- 11/18/21, the facility failed to ensure the environment remained as free of accident hazards as possible and that each resident received adequate supervision and assistive devices to prevent accidents for 2 of 4 residents (Residents #75 and #113) reviewed. Specifically, Resident #75 was provided a hot beverage that had been microwaved by staff, the resident spilled the beverage and the resident sustained burns to their abdomen and thigh. Resident #113 was provided hot water by a staff person without ensuring proper temperature before serving. This resulted in actual harm to Resident #75 that was not an immediate jeopardy.

Inspectors wroteBased on observation, record review and interview during the recertification survey conducted 11/15/21-11/18/21, the facility failed to ensure all residents were provided an ongoing program to support residents in their choice of activities and designed to meet their individual needs based on the comprehensive assessment and care plan and the preferences of each resident for 1 of 3 residents (Resident #10) reviewed. Specifically, Resident #10 was not provided meaningful activities as care planned.

Inspectors wroteBased on observation, interview, and record review during the recertification survey conducted 11/15/21-11/18/21 the facility failed to ensure drugs and biologicals were labeled in accordance with currently accepted professional standards, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for 1 of 3 unit medication rooms (Unit 2EE) and 1 of 4 medication carts (medication cart #8) reviewed. Specifically, the Unit 2EE and medication cart #8 had stock medications that were expired or outdated beyond the opened date.

Inspectors wroteBased on observation and interview during the recertification survey conducted 11/15/21-11/18/21, the facility failed to ensure each resident received food and drink that was palatable and at a safe and appetizing temperature for 2 of 2 meal trays (lunch and dinner) tested. Specifically, food was not served at a safe and appetizing temperature for a lunch and dinner meal.

Inspectors wroteBased on observation, record review and interview during the recertification survey conducted 11/15/21-11/18/21, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 2 of 8 unit pantry refrigerators (Units #1 East and 2 West) and 1 kitchen tray line refrigerator observed. Specifically, air temperatures were not maintained for Unit #1 East and 2 [NAME] pantry refrigerators at 40 degrees Fahrenheit (F) or lower. Additionally, the kitchen tray-line refrigerator air and food temperatures were not maintained.